Primary Care Coding Alert

Question: How should I report destruction of anal lesions? Our FP destroyed two anal lesions, and I am stumped on the code choice.

Alabama Subscriber

Answer: It depends on the method the FP used in the procedure, and the extent of the destruction. Anal lesions can be removed via multiple techniques, and CPT includes codes for each of these methods.

Check the op notes to see if you can determine the FP's removal method.

Then, you can use this key to guide yourself through the different techniques the FP might use to destroy anal lesions:

• If the FP uses chemicals to destroy the lesions, report 46900 (Destruction of lesion[s], anus [e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle], simple; chemical).
• If the FP uses electrodessication, report 46910 (... electrodessication).
• If the FP uses cryosurgery, report 46916 (... cryosurgery).
• If the FP uses laser surgery, report 46917 (... laser surgery).
• If the FP uses surgical excision, report 46922 (... surgical excision).

Extensive-destruction alert: If the notes indicate extensive destruction of lesions, report 46924 (Destruction of lesion[s], anus [e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle], extensive [e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery]) regardless of the removal method.

ICD-9 alert: No matter what code you choose for this encounter, remember to include ICD-9 code 569.49 (Other specified disorders of rectum and anus; other) on the claim to represent the patient's lesions.